A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession

摘要

The 2007 global economic recession was the most severe recession since the Great Depression of the 1930s in terms of declines in unemployment, labor force participation and gross domestic product in the United States. In order to guide future public health policies during economic downturns, we reviewed and synthesized the literature on the health consequences of the current and prior recessions focusing on the government response to the recession in the United States. We searched for primary literature in three academic and three policy databases using the indexed and free-text terms “recession”, “health”, “mortality”, “employment”, “unemployment”, “foreclosure”, “pensions”, fiscal”, “deficit”, “morbidity”, “avoidable mortality”, “amenable mortality”, “budget”, and “budget crisis” in various combinations. The search resulted in 172 English language studies published from 1 January 1980 through 1 April 2013 that met the inclusion criteria. The data synthesis was structured into two themes: new developments in our understanding of changes in morbidity or mortality risk related to recession or fiscal austerity, and public health system responses to the recession under fiscal constraints. We found consistent evidence that recessions, and unemployment in particular, can be significantly damaging to mental health, increasing the risk of substance abuse and suicide particularly for young men. We also found that the previously reported mortality declines during recessions may occur in only a few causes of death such as reduced automobile deaths. In addition, the expansion of Medicaid, Supplemental Nutrition Assistance Program, and unemployment benefits under American Recovery and Reinvestment Act of 2009 likely had substantial buffering effects on health, especially among poor women and their children. These programs often excluded young single men, who are at highest risk of substance abuse and suicide. Thus, these populations should be targeted during downturns or integrated into safety net programs before the next recession.